Friday, December 14, 2012

Understanding Psych Evaluations

www.gacasa.org/.../UNDERSTANDING%20PSYCH%20EVA.

Andrew M. Gothard, Psy.D., P.C.
Licensed Psychologist
_____________________________________________
2308 Perimeter Park Drive 770-457-5577
Suite 100 fax 770-457-5599
Atlanta, GA 30341 andygothard@bellsouth.net
UNDERSTANDING
PSYCHOLOGICAL
EVALUATIONS
Course Description
This course will provide CASA
volunteers, GALs, and DFCS personnel
with basic understanding of how to read
and interpret a basic psychological
evaluation report, focusing on
information most pertinent to your work
with DFCS children and families.
What is a psychological
evaluation
It is NOT:
• A “psychiatric evaluation”
• A “neurological evaluation”
It IS:
• A formal evaluation including several basic
components:
Interview, records review, collateral contacts, oneon-
one testing, diagnosis, recommendations
2
When is a psychological
evaluation needed?
Mandated for all children taken into custody
Periodic updates are required for children in
long-term foster care
Drug & Alcohol Evaluations
• When issues are suspected, but cannot be
confirmed, such as if client denies, or minimizes,
drug or alcohol use
• When treatment options need to be determined
When is a psychological
evaluation needed?
Fitness for Parenting Evaluations
Either legally based or information based
• Legally-based – Such as when petitioning for nonreunification
or termination and an expert will help
to bolster your case
• Information-based – when it is suspected that there
are issues such as mental health concerns,
substance abuse, cognitive deficits, dysfunctional
parenting beliefs and attitudes that could
significantly impair ability to parent
Anger-Violence Assessment/
Domestic Violence Assessment
• When issues are suspected, but cannot be
confirmed, such as if client denies any
violence
• When treatment options need to be
determined
When is a psychological evaluation
needed?
3
Psychosexual Evaluations
• When sexual abuse perpetration or
victimization is alleged or suspected, but not
necessarily confirmed
• When treatment options need to be determined
When is a psychological evaluation
needed?
When is a psychological evaluation
needed?
Psychosexual Evaluations
• BEWARE – A psychosexual evaluation is not the
same as a formal forensic sexual abuse interview.
Forensic interviews are often needed if criminal
charges are pending; these need to be done ASAP
after allegations are made.
• For standard psychological evaluations, the good
psychologist will very carefully do minimal questioning
regarding allegations of sexual abuse, so as not to
contaminate the evidence if a forensic interview is to
occur afterward.
When is a psychological
evaluation needed?
Neuropsychological Evaluations
• For use when there are suspicions of
dementia (e.g., Alzheimer’s), serious cognitive
deficits, serious memory deficits, if there has
been a significant head injury or trauma
• Will sometimes be recommended as part of
the initial psychological evaluation
• Very costly and therefore not covered by
Medicaid
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There is no set standard
Detailed clinical interviewing, including
collateral and corroborative sources
Behavioral observations
Review of available records
What makes a good general
psychological evaluation?
What makes a good general
psychological evaluation?
Validity must be addressed
Testing includes IQ screening, academic
screening, visual-motor functioning,
personality-emotional-behavioral
functioning (both objective and
projective)
There is no set standard
Includes interviews (with client and
collateral), records reviews, behavioral
observations IQ screening, academic
screening, visual-motor functioning,
personality-emotional-behavioral
functioning (both objective and
projective) that is part of a standard
psychological
What makes a good Fitness for
Parenting Evaluation?
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What makes a good Fitness for
Parenting Evaluation?
Additionally, it also includes tests
specifically designed to measure
parental beliefs and attitudes
VALIDITY MUST BE ADDRESSED
Why can’t you do just a parenting eval
without it being part of a full
psychological eval?
What makes a good Drug &
Alcohol Evaluation?
There is no set standard
VALIDITY MUST BE ADDRESSED
You get what you pay for! Most “bargain”
A & D evals will not stand up in court
against strong cross-examination
What is validity?
• A valid evaluation is one that accurately measures
what is says it will measure – an accurate measure of
the client’s cognitive abilities, emotional functioning,
parenting beliefs and attitudes, etc.
Why are validity indicators needed?
• Because much of the information gathered in a
psychological evaluation is self-reported by the client
• Because your clients are motivated to look as good as
possible.
Validity concerns
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Types of validity problems
• Faking good
• Faking bad
• Inconsistency
Validity concerns
Validity concerns
Informal validity indicators – e.g.,
comparison of self-report with records
and collateral contacts
Validity assessments aren’t fool-proof
A forensic evaluation that does not
address validity is never a good thing
Is it OK for the psychologist to
use templates?
They are imperative if you don’t want to
pay $$$ for evaluations
No need to reinvent the wheel
Liability? Can result in typos and other
errors (he/she; him/her)
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Is it OK for the psychologist to
use assistants?
Financial constraints – Allows me to give
you a superior product at a substantial
discount off of “retail” rates
Allows for multiple perspectives
Limitations of psychological
evaluation
Available data – is it complete?
Accuracy of data
“Snapshot in time”
Predicting the future
Determining ultimate, “black or white”
questions (e.g., Is this a fit parent?)
Psychiatric evaluation is typically for
medication
Psychiatric evaluation is much more
limited in scope that psychological
Psychological evaluation is much more
in-depth, and can answer all questions
except for prescribing specific
medication
Difference between
psychological and psychiatric
8
Difference between
psychological and psychiatric
Psychological can be used as a
screening for if a psychiatric is even
needed
Many (but certainly not all!!) psychiatrists
will nearly always prescribe medications
if there is a valid diagnosis (depression,
ADHD, anxiety, etc.)
What does “rule out” mean when part of a
psychological/psychiatric diagnosis?
“Objective” vs. “Subjective”
• Applies to how information is obtained (i.e., test
administration) and how tests are scored and
interpreted
“Projective” Tests
Miscellaneous issues:
Can you give a copy of the report to the
client?
•Forensic evaluations that are requested
(especially if they are court ordered) and
paid for by a third party (DFCS) are
different than other medical records – the
client is not automatically entitled to a
copy of the report
Miscellaneous issues:
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Miscellaneous issues:
Can you give a copy of the report to the
client?
• DFCS records are protected and confidential by state
statute; the psychological report, in essence, becomes
part of the DFCS record, so DFCS owns the rights to
the report, the psychologist cannot give the report to
the client without specific permission from DFCS
• There are legal ramifications regarding the status of
the court case – best to always ask your SAAG first!!
• Although “discoverable,” judges do not always require
the SAAG to give the report to the defense attorney
What makes a good psychologist for
DFCS’ needs?
Ability to develop rapport with wide variety of
culturally and ethnically diverse clients
Ability to develop rapport with difficult clients
• Non-compliant children; angry adults
Ability to write reports that are understandable
to a wide range of readers – no “psychojargon,”
average reading level
What makes a good
psychologist for DFCS’ needs?
Understanding of and ability to work well with the various
systems involved (DFCS – CPS, ongoing, etc.; referral
agencies; DJJ; YDC; schools; attorneys)
Ability to be an effective expert witness in court
Ideally, should be a “forensic psychologist” since nearly
all DFCS cases go to court, thus any evaluation could
require expert testimony
Ability to be a therapist as well as an evaluator
Service - fast appointment times; fast general turnaround
times; ability to handle “rush jobs;” ability to do “off-site”
evals
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Recommendations
These often are considered to be a mandate
that DFCS must follow!
Therapeutic –
• Individual therapy
• Group therapy
• Family therapy
• Psychiatric evaluation for medication
• Substance Abuse treatment
• 12-step meetings
• Routine drug screens (random, unannounced, &
observed)
Recommendations
Further evaluation -
• Baby’s Can’t Wait
• Developmental pediatrician (for Pervasive
Developmental Disorder, Autism, Asperger’s,
etc.)
• Comprehensive psychoeducational evaluation
• Neuropsychological evaluation
• Psychosexual
• Forensic Interview
Recommendations
Related services –
• Speech therapy
• Occupational therapy
• Educational
Social –
• Extracurricular Activities
• Mentoring
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Recommendations
Specific recommendations regarding the
parents for children evaluations are not
made if we have not met the parents.
Reunification, non-reunification,
termination of parental rights, etc.
usually is not addressed. Exception is
when recommending a
psychological/fitness for parenting
evaluation.
Thank You!
Andrew M. Gothard, Psy.D., P.C.
Atlanta Psychological Services, LLC
770-457-5577
andygothard@bellsouth.net